Foreign doctors, our values

[wayneinfl]

I was actually kind of curious how far you guys would let me take this. Does that mean we're done?

[Rob]

If I were you, I'd *be* done, as the foreign doctor and the lesbian on the board are both offended.

[wayneinfl]

You're not foreign Rob. You're in Arizona.

Who's the lesbian? I knew some of you had relatives who were lesbians, but I had no idea some of you were lesbians, too.

Don't mean to offend anyone. This is what I'm like when I'm in a good mood. I probably need to learn to use the smilies. I forget this is the internet. I'm barely tolerable in real life, let alone when I'm across a computer screen, because you can't see how much I'm laughing trying to argue a ridiculous point just for the sake of argument.

[Georgina]

Who has relative lesbians?

[Rob]

I'm pretty sure that a half-lesbian is relative.

[Rob]

And now that I think about it, being foreign has to be relative too.

[wayneinfl]

Who has relative lesbians?

I do, for one. One of my cousins is a lesbian. I have a gay male cousin, too, but to my knowledge he's never come out. He needs to though. Everybody already knows anyway.

Doesn't Gael have a duaghter who's a lesbian? Or was it one of her daughter's friends?

[Georgina]

Argued properly, I would think most things could be construed as relative. Including my being half-lesbian.






Sidebar to Wayne: Turnabout is fair play in chain yanking.

[Calluna]

(Edit: I posted this before I saw the second page was here and that wayne really was just joking, so I'm removing the now irrelevant paragraph...just in case someone read it before I got it back out.)

It sounds like Canada is falling victim to its own cultural sensitivities, though, by not wanting to "single out" specific countries when considering who to license to practice in the country and who might need additional training before being licensed to practice.

There are many countries in the world where physician training is of a high standard and it really isn't necessary to make it so difficult for someone to move and practice in a new country.

On the other hand, there are also countries where medical training IS substandard, or where the actual medical side of the training is not accompanied by the same ethical training, and I don't see any reason to ignore this. In fact, recognition of these differences in training is the basis of some partnerships our own medical school has with those in other countries to help raise their standards...the countries with which we are forming partnerships are not oblivious to this fact, they have requested the assistance, recognizing they do not have enough qualified educators to train their students, so they basically have us training their students and the students we train then get retained as educators in their own institutions.

Yes, these partnerships also require recognition of cultural differences. We have to ship cadavers to Oman to supply their anatomy labs, because their culture requires quick cremation after death, so nobody donates bodies there. Cultural differences CAN be overcome, but that first requires recognizing they exist, and not trying to ignore them as if there is something wrong with them and you're trying not to stare.

In fact, there may be ways that some cultural differences can be put to good use in Canada, or other countries. There very well may be patients who share these cultural values who are uncomfortable seeking a physician who does not share them. Perhaps Muslim women would only want to see a female physician, and preferably, another Muslim female who understands their cultural needs.

The catch is that if the cultural background hinders their practice of medicine, such as a physician unwilling to touch a patient to perform a proper physical exam, then this needs to be addressed, and additional training provided before they should be licensed to practice independently.

[oskar]

Hmmm. Is that the same as American doctors who refuse to prescribe contraception pills because it's against their religion? Is it because of that American culture or is it due to sub-standard medical training in the US?

[Calluna]

Feb 8, 2009 11:29:41 GMT -5 oskar said:

Hmmm. Is that the same as American doctors who refuse to prescribe contraception pills because it's against their religion? Is it because of that American culture or is it due to sub-standard medical training in the US?

It's due to culture/religion. I did distinguish between substandard training and cultural differences. Canada's laws are different than US laws, so certainly a doctor from the US moving to Canada who holds such views about contraception would need to be educated about Canada's laws. Again, I don't think it's a bad thing, or condemnation of a culture to recognize there are cultural differences that need to be addressed when someone desires to practice certain professions in a new country.

Let's spin it around the other way...if a physician from the US or Canada were to travel to a Muslim nation in the Middle East, they could not just apply US or Canadian cultural standards to treat patients in the new country...they need to apply the local cultural standards. I wouldn't expect it to happen the other way around, where the local community has to just suck it up and accept the cultural standards of the physician stuck in their community even if they drastically differ from theirs.

As I said before, because of the cultural diversity within the US and Canada, there may be ways to use these cultural differences to the advantage of different pockets of ethnic/cultural communities, but that still requires recognizing these differences exist. I just don't understand why there is always such a knee-jerk reaction that recognizing cultural differences is a bad thing. And, it is also important to make the distinction between cultural differences and quality of medical education. If there are skills lacking in the physicians coming from other countries that are needed to practice in the country to where they have moved, then they need to receive training in those skills. Those skills may be related to cultural sensitivities, or how to work within the healthcare system of that country, and might not prevent them from starting to work as a physician immediately, while taking some workshops to address these issues. If those skills are more regarding their medical knowledge or using the diagnostics available, or how to perform certain aspects of physical exams that are not permitted in the country where they came from, then they may need to undergo additional training, such as redoing a couple of years in residency, before getting licensed. But, again, that's part of the issue. Trying to avoid singling out specific countries of origin makes it impossible to customize the training needed.

And, yes, I would think someone moving from the US to Canada, or Canada to the US, would still need some training to work in a new country. Laws do differ, so do the ways insurance and paperwork are handled, etc. While the physicians are equally competent to practice medicine, there are some aspects of navigating the "systems" that do differ and they should learn, because even that impacts patient care.

[crazielollie]

I consider myself lucky to be able to choose my doctor (vs having the insurance company do it for me). Calluna makes good points about cultural differences and laws. Even within "our culture", there are differences in doctors. The doctor/patient relationship is an extremely personal one. Some doctors are very flexible, some are not. The question of how a particular medical problem should be treated (and there are almost always options) should be something the patient and doctor discuss. Some doctors do this, others don't. I run from the ones who don't. Doesn't matter where they were born, raised and taught, if the doctor and patient aren't in sync, it's less probable he/she will be consulted when a problem arises and is therefore much less effective for that particular patient. A doctor disapproving of my lifestyle may let his/her personal prejudice interfere. Even if it's only that the doctor spends a little less time giving me the pros and cons of a treatment or the alternatives, it's a bad situation.

Yes, they should be beyond that but doctors are human beings just like the rest of us. This has come up before. Why would anyone want a doctor who disapproves of them, their lifestyle or their beliefs? I share freely with a doctor who accepts things as they are. It would be hard to share anything with a doctor who actually condemns aspects of my life and says so. The less I share, the less effective the doctor can be.

[joethree56]

I consider myself lucky to be able to choose my doctor (vs having the insurance company do it for me).

We in Britain have this as of right

On the main topic though, I would not expect to find a vegan applying for a job in a slaughterhouse any more than I would comtemplate becoming a priest. The bottom line is that ones personal beliefs have no place spilling over into ones profession be they cultural or otherwise. I do not expect to have to interview my doctor on his or her cultural background before deciding if they are competant to treat me.

[Georgina]

Feb 8, 2009 10:45:35 GMT -5 Calluna said:

It sounds like Canada is falling victim to its own cultural sensitivities, though, by not wanting to "single out" specific countries when considering who to license to practice in the country and who might need additional training before being licensed to practice.

Canadian social policy is notoriously terrified of offending anyone. We've taken the whole philosophical idea of being a cultural mosaic and social inclusiveness a few steps too far in more than one instance. And we have complaint mechanisms in place that facilitate and even encourage the boundaries being continuously pushed.

Feb 8, 2009 13:37:26 GMT -5 crazielollie said:

I consider myself lucky to be able to choose my doctor (vs having the insurance company do it for me).

I cannot even begin to imagine a system in which some clerk in a call centre gets to choose my doctor for me.

[Rob]

Whew. I'm so glad you horrid socialists have drawn the fire from us foreign doctors.

[Georgina]

Dang ferners.

However it's under consideration that some foreign doctors might be excused given that they too are horrid socialists and etc, but it will take some convincing.

[Pax]

We're having enough trouble finding things to argue about, that we have to invent a few now just for fun?

I'm sorry I missed the whole lesbian discussion. I feel, like Oskar, that I am a bit of an expert with the demographic, trapped as I lesbianly am in the body of a man. Though I did learn something new... now I know definitively that my man-boobs come from my sexual practices rather than my eating habits.

[Georgina]

Food was a consideration?! How did food get involved in this?

[Rob]

I was lost a long time ago, which is unfortunate as I do have some experience both with medical/cultural conflicts and with lesbians.

[Georgina]

Which, in all seriousness, I'd more than like to hear about.

Edited to add: Well, okay. I can live without the lesbian parts. I know your medical/cultural conflicts experience is interesting.

[Calluna]

I'd like to hear Rob's perspective on this too, as both a foreign doctor AND one who has been immersed into a culture even quite different from those in the rest of the country into which he has landed in.

As for lesbians, I can relate that one of my coworkers encountered some interesting prejudices when her partner was pregnant and going through a delivery with some complications (pregnant via artificial insemination...no prejudices encountered at the fertility clinic at least). She said, one issue she encountered was simply being allowed into the delivery room since she wasn't the "husband." Once that was settled, she said it was more the nurses than doctors, who seemed surprised she was every bit as attentive and worried as any expectant father would be. This particular coworker is pretty, um, direct in her words, and apparently had several for one of the nurses. The nurse came by the next day and apologized...she apparently gained some new perspective on lesbian relationships.

[Rob]

Let me just say that I think most people make the assumption that the docs' beliefs are somehow more primitive than those of the culture, which is far from universally true.

[oskar]

Food was a consideration?! How did food get involved in this?

I hope that was rhetorical.

[Pax]

Oh for God's sake are we seriously discussing "lesbian-specific" diseases? How the hell can ANY disease be "lesbian-specific?" Lesbians don't do anything that straight people don't do. The whole topic is homophobic and that doctor should be bullwhipped.

[wayneinfl]

No. We were not "seriously" discussing lesbian specific diseases.

[Pax]

Never mind, I accidentally was looking at page one of this topic.

Consider my fit officially unpitched.